France Donnay: “For many newborns, the day of birth is also the day they die”

The world is undergoing profound changes that affect public health in general and maternal health in particular. During her talk, Dr. France Donnay, adjunct professor at the Tulane School of Public Health in New Orleans and consultant in maternal and child health, described the tendencies in maternal health over the last decades and the factors that will shape it in the future.   

Maternal deaths (i.e. those that occur during pregnancy, labor and up to 6 weeks after delivery) have considerably decreased worldwide (from an estimated 500.000 deaths in 1990 to less than 300.000 in 2015), although there is regional variation in the rates and causes. While most maternal deaths occur in sub-Saharan Africa and Southern Asia and are mainly due to postpartum hemorrhage, the main cause of maternal deaths in the developed world is hypertension.   Childhood mortality (under five years of age) has also decreased considerably worldwide, but early neonatal mortality remains high. In India, for example, 800,000 neonates are estimated to die every year. Around one third of neonatal deaths actually occur on the day of delivery, and the main causes are premature birth, birth asphyxia and neonatal infections. More than 90% of such deaths could be avoided with basic resurrection interventions. Given that most maternal deaths also occur at labor, the lives of many women and newborns could be saved by an increased access to medical attention on the day of delivery.

The good news is that, over the last years, the number of women that deliver in health centers has increased worldwide. This is due in part to trends such as urbanization that favor a change in care-seeking behavior. Antenatal attention has also increased, although postnatal follow-up remains very low. The problem now is to ensure that the health centers are able to cope with the increasing number of women attended in the clinics. Another challenge consists in dealing with the “double burden of disease” that is emerging in low and middle income countries, where up to 50% of deaths of women in reproductive age are due to non-transmissible diseases (diabetes, hypertension, cardiovascular disease) that have a high impact on the baby’s survival.    

The expert presented a series of solutions to deal with the future challenges in maternal health and highlighted the importance of creating a narrative and explanations for health care staff and patients that have a link with the cultural references. This is a time of opportunities, she concluded, but the challenge now consists in converting the available resources into good quality care for mothers and newborns.